Hand metastasis in renal cell carcinoma.

H metastases in renal cell carcinoma (RCC) are rare1–3 and may mimic benign lesions with consequent misdiagnosis.1,2 The lesions present diagnostic and therapeutic challenges. We illustrate the case of a patient with metastasis of RCC to the phalanx. A 69-year-old man who underwent left nephrectomy 4 years ago for RCC (pT3N0M0, Stage IV) presented with a painful enlargement of the middle phalanx of the middle finger. X-rays (Fig. 1) demonstrated osteolysis of the phalanx and multiple lung metastases. Exarticulation of the proximal interphalangeal joint with primary closure under local anesthesia was performed. The histologic examination confirmed metastatic RCC. The patient refused systemic therapy and died 15 months later of disseminated metastatic disease. RCC shows a high incidence of osseous metastases, with a predilection for the scapula.2 Metastases in the hand skeleton, however, represent about 0.1%1,2 of all possible bone metastases, and only 10% of them originate from RCC.1 Any bone can be involved,3 but, most commonly, hand metastases are found in the distal phalanxes.3 Nevertheless, physicians should have a high degree of suspicion when patients with RCC present with swelling in the hand. In our patient, faced with advanced metastatic disease, a simple amputation under local anesthesia was performed instead of a finger-preserving procedure necessitating a lengthy rehabilitation. Prompt and aggressive1,2 surgical treatment may contribute to a higher quality of life in the symptom-free interval.